Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.

Novel Applications for Topical Agents in the Management of Pain

GOALTo provide healthcare professionals with the most current information about topical agents in the management of pain.

TARGET AUDIENCEThis activity is designed for nurse practitioners active in pain management, managed care pharmacists and all hospital-based directors of pharmacy, oncology pharmacists, and chief pharmacists. No prerequisites required.

LEARNING OBJECTIVESThe Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

Understand current hypotheses on the pathophysiology and mechanisms of chronic pain.

Discuss classic pharmacologic treatment strategies for pain management and the rationale for such approaches.

Review the risks versus benefits of emerging pharmacotherapies for the treatment of chronic pain.

Discuss the role of topically applied analgesics in clinical pain management.

ACCREDITATION STATEMENTThe Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENTThe Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 1.5 hours.

Release date: July 15, 2003. Expiration date: July 15, 2005.

This program is approved for 1.5 hours (0.15 CEUs) and is cosponsored by the University of Tennessee College of Pharmacy, which is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmaceutical education. A statement of CE credit will be mailed within 4 weeks of successful completion and evaluation of the program. ACPE program# 064-999-03-234-H01.

CONTINUING NURSING EDUCATION ACCREDITATIONThis activity for 1.5 contact hours is provided by the Institute for Johns Hopkins Nursing, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

DISCLAIMER STATEMENTThe opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Endo Pharmaceuticals.

Full Disclosure Policy Affecting CME Activities:As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. Program Directors and Participating Faculty reported the following:

PROGRAM DIRECTOR

Peter Staats, MDProfessorDepartment of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimore, Maryland• Dr Staats reports receiving grant and/or research support from the American Neuromodulation Society, Elan Corporation, and Medtronic; and serving as a consultant to the American Neuromodulation Society, Elan Corporation, Johnson & Johnson, Medtronic, and Pfizer, Inc.

Notice:In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity contains reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty member has disclosed that his article has referenced the following unlabeled/unapproved uses of drugs or products:

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Novel Applications for Topical Agents in the Management of PainPeter Staats, MD*

Fears of impaired mental function and drug dependency act as major deterrents in the use of oral analgesics. The result is a renewed interest in the use of topical application of nonsteroidal anti-inflammatory drugs, opioids, capsaicin, local anesthetics, and alpha-adrenoceptor agonists, which are all being investigated and used for varied pain conditions. Additionally, preclinical studies offer scientific evidence supporting the development of new topical formulations of agents typically taken orally. Combined, these findings offer new options for patients who seek pain relief, but who do not wish to experience significant systemic absorption and risk drug-drug interactions. These risks are particularly apparent in the treatment of elderly patients, who may be fearful of falls or who may be taking multiple medications.

This issue of Advanced Studies in Medicine is based on the proceedings of the 22nd Annual Scientific Meeting of the American Pain Society (APS) in Chicago, Illinois, March 20-23, 2003. Recent clinical evidence surrounding the use of clinically approved and experimental topical analgesics and summary information related to transdermal therapies, applied with patches on the skin but absorbed systemically to achieve therapeutic drug serum levels, are presented.

Gary McCleane, MD, from the Rampark Pain Centre, Lurgan, N Ireland, summarizes the medical literature surrounding the topical use of nitrates, capsaicin, and tricyclic antidepressants for pain management. Jana Sawynok, PhD, an internationally recognized researcher who has published extensively in the area of biochemical and pathophysiologic mechanisms of pain, presents an overview article of recent clinical findings surrounding the topical use of tricyclic antidepressants to achieve analgesic effects. Dr Sawynok also offers a comprehensive review of medical evidence surrounding the full range of topical agents.

Charles E. Argoff, MD, from North Shore University Hospital, and New York University, discusses the adjunctive role of topical analgesics, including topical formulations of opiates, in pain management. He presents recent clinical evidence suggesting that topical analgesics, which are typically viewed as acting on peripheral pain mechanisms, also may play a role in the central processing of pain. He reports on a series of clinical studies demonstrating novel applications of topical agents in centrally mediated pain, including osteoarthritis.

Also included within this issue are summaries of selected poster presentations from the APS meeting, as well as abstracts of recent articles from the medical literature. The combined medical evidence reported in this publication suggests new options for clinicians faced with the challenge of treating the 50 million Americans who have chronic pain. Topical agents, used alone or in combination with other therapies, are proving to be both safe and effective in reducing pain and improving function in patients with a variety of neuropathic and nonneuropathic pain states.

*Professor, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.